Certain foods have fat-promoting actions, causing changes in hormones and metabolic activities that increase the risk for fat accumulation and obesity; whereas, other foods have fat-fighting actions. Fat-promoting foods, if avoided and replaced with items that reduce the risk for fat accumulation, would help to maximize weight loss success and long-term maintenance post-surgery. Over the next several issues of the Silhouette, the research section will examine foods that promote fat and those that may help to reduce the risk for obesity. The first of this series of articles discusses why processed grains increase the risk for obesity and why, calorie for calorie, processed grains are so much more fattening than whole grains. 

Whole Grains vs. Processed Gains
Do you know the difference between the terms ‘whole grain’ and ‘processed grain’? A whole grain is the seed of the plant and consists of 3 major components. The first of these is the bran or outer layer of the seed, which is high in fiber, vitamins, minerals, and phytonutrients. The center of the seed is the germ and it, too, is high in vitamins, minerals, as well as protein and fat. The third part of the seed is the kernel and consists primarily of carbohydrate. Whole grains, then, contain all the components of the plant seed, along with its high fiber content and nutrients.

Refined or milled grains are those that have had the bran and germ removed through high-heat roller mills. Such processing removes the nutrient and fiber content of the grain, leaving behind the carbohydrate kernel. The advantage to refining or milling is to increase the shelf life of the product. Processed grains vs. whole grains have a much longer shelf life and are resistant to pests, such as rodents who prefer to eat the nutritious parts of the grain. To increase the nutrient value of the processed grains, manufacturers ‘enrich’ or, in other words, add back to the refined grain some but not all of the lost vitamins. Until recently, most grain products in the grocery market were processed or refined including bread and baked goods, cereals, crackers, and rice products. 

Calorie-for-calorie processed grains are more fattening than are whole grains and for several reasons. First, processed grains contain mainly carbohydrate and, when consumed, are rapidly absorbed, resulting in an increase in blood sugar. The rise in blood sugar results in a concomitant increase in the production of insulin, the hormone that regulates sugar in the body. Insulin lowers blood sugar levels by promoting the uptake of sugar into tissues and by stimulating its metabolism or storage. However, insulin can also increase body fat. 

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“So, why do you perform bariatric surgery?” This is a question that patients, healthcare providers, and even some of my own family members ask. This question is the very reason why many of us become Bariatric Surgeons.

My exposure to Bariatric Surgery is probably not much different than your own surgeon. In the early 1990’s, I was fortunate to train in a program where some of the best and brightest attending surgeons were doing an operation called the Roux-en-Y Gastric Bypass. It was relatively unknown by many patients at that time. I worked with my mentors in Bariatric Surgery every opportunity I could, and I enjoyed the technical aspects of the procedure. As I completed my training, I knew that I wanted to develop a career fashioned after my mentors who trained me.
 
When I completed my training, I began my own practice as a Bariatric Surgeon. It really wasn’t until I saw first hand the impact these lifesaving procedures had on people that I began to understand why my teachers performed Bariatric Surgery. It isn’t really about the weight loss. Rather, it is about taking a person who struggles with diabetes; or the person who suffers with obstructive sleep apnea; or even someone who cannot participate in life because of body size limitations, and embarking on a journey with them to help them find a new life. The ability to offer people a new life, without the burdens of diabetes, sleep apnea, that can now move more freely to enjoy life is a very satisfying experience.
 
Bariatric Surgery has come a long way since the 1990s.  Multidisciplinary programs allow bariatric surgeons to interact with a broad range of healthcare professionals like dietitians, physical therapists, behavioral health specialists, exercise specialists and nurses who all work together to achieve one goal: help people achieve a healthier life. So why do I do Bariatric Surgery? I, like your own surgeon, do it because I believe it is the best job in medicine. If you haven’t visited your bariatric program in a while, please do so. We all are committed to not only perform the surgery but also support your ongoing success.

By Troy Glembot, MD, FACS

Why Taking Your Vitamins May Also Help to Prevent Weight Regain
By Cynthia K. Buffington, Ph.D.

Micronutrient ‘repletion’, the state of fulfilling your body’s vitamin and mineral requirements through a wholesome diet and/or supplementation, may help to maximize weight loss success and maintenance. Vitamins and minerals are essential factors and co-factors for numerous biological processes that regulate body size, including appetite, hunger, nutrient absorption, metabolic rate, fat and sugar metabolism, thyroid and adrenal function, energy storage, insulin action and blood sugar levels, neural activities and much more. Thus, micronutrient ‘repletion’ is likely to be essential for maximal weight loss success and long-term weight maintenance.
 
According to a recent study1, a ‘micronutrient replete’ diet, even one that is not low in calories, induces weight loss.   In the study, a group of obese females were required to eat prepared meals that were complete in all the necessary vitamins and minerals. The study participants could eat additional foods only if they had consumed all of the food provided which, by the way, averaged 2100 calories. The data showed that such a diet, although not low in calories, was capable of inducing significant weight loss, particularly in the abdominal region of the body where fat accumulation is most significantly related to the development of diseases, i.e. diabetes, hypertension, heart disease, liver disease, and more.
 

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My new life started September 2005. After trying every diet that man created, l knew that dieting was not the way out for me. I weighed 375 pounds and l was still getting bigger. I hated myself and hated everyone around me.   I knew l was ready… no second thoughts… even though l was scared there was no other choice. I took the leap and had bariatric surgery. Sticking to the diet was the hardest thing l have ever done. The first month was very tough. I hated it and was sorry that I did had surgery. At one point, l even wanted to have the procedure reversed. 

I sat down and took stock of myself. I had to do this because l knew the challenges that I was going through would be worth it at the end.   

Now l sit here after losing 170 pounds. I now wear normal cloths and fell so much better about myself. For the first time in my life, l truly like myself. l also believe that I now have a purpose in life…I never felt this way before!
 
Sure it was tough in the beginning. But as time went by, things got easier and my new life was born. Was it worth it? You answer that question after you see my before and after pictures.

Mary Ann Radmacher once wrote, “Discover the tools to build your own vision.” The surgery was a tool to aide in the weight loss and now you may find your toolbox getting empty. The weight loss has slowed down or you’re at your goal weight. The “honeymoon” period has ended and now reality is settling in. The lifestyle changes are of the most importance and they need to be consistent and constant.
 
Many times at this point in the journey, I find patients calling with various issues arising. Often I hear from patients; “I don’t know what to do with my body. My husband doesn’t pay attention to me. I feel guilt over having the surgery. I feel bad because I like me. I feel guilt over my kid’s weight. I feel guilty when I take time to exercise. I’m having cravings. I want to go back to my old ways.” The list goes on. I find that patients are frequently overwhelmed and stalled. They don’t know where to go!    
 

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The professional medical literature has well documented that morbid obesity affects health in numerous ways, including impacting the female reproductive system. Increasingly, many women seek weight loss surgery with the hope of resolving infertility that is related to conditions such as polycystic ovary syndrome (PCOS), or failure to conceive without diagnosed pathology. Our bariatric center has had dozens of such patients present for weight loss surgery over the past six years.

During the pre-operative evaluation period, patients are informed that it is unsafe for both patient and fetal health for pregnancy to occur in the first 18-24 months following gastric bypass surgery. This is the time period corresponding to rapid weight loss and possible nutritional insufficiencies. Some patients who have tried unsuccessfully to conceive, sometimes for years, are frequently distressed to learn of this additional delay to their well laid plans. Other patients are concerned about their ability to carry a pregnancy and deliver a healthy baby after weight loss surgery. On a very positive note, the good news is that post-operative gastric bypass patients who closely follow the recommendations of their bariatric surgery team and knowledgeable obstetricians can have a pregnancy and delivery free of complications resulting in a healthy baby. According to William P. Homan, M.D., Director of New York Bariatrics, the guidelines to a healthy pregnancy following gastric bypass are quite clear: 1) use reliable contraception and do not become pregnant too soon; and 2) prepare for pregnancy by becoming (and staying) nutritionally well-balanced.

On the issue of the timing of your pregnancy, Dr. Homan states that the 18-24 month waiting period is crucial. “Patients are losing weight at a rapid rate in the first months after surgery. The very window of opportunity that makes the surgery so effective for weight loss is potentially disastrous to the developing fetus.” Dr. Homan describes a presentation at the 17th Annual Meeting of the American Society of Bariatric Surgery in

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Morbid obesity affects approximately 9 million Americans and it is on the rise and an increasing problem for our society. It negatively affects those that suffer from it medically, emotionally and even socioeconomically. If you are over 100 pounds overweight or have a BMI (body mass index) of over 40, you are considered morbidly obese. The chances of premature death are quite high in comparison to those at normal weight. This has been shown to be the case statistically, but it is also a logical outcome of its association with so many medical conditions. If there is any good news here, it is that effective treatment for a morbidly obese person can lessen these risks dramatically.

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While on the cusp of the summer solstice, June 20, we are in full swing of the season. At the box office, Sex & The City beat Indiana Jones in ticket sales. When the going gets tough, release a chick flick and women will respond in  big numbers! Of course I went to see Sex & The City with several gal pals on opening day, having purchased my tickets  online  in advance. These gal pals are a talented group, comprising of one fashion illustrator, two authors, several clothing designers - all with one common thread, we all teach or have taught fashion courses at university level or at a respected design school. This  was a tough crowd to judge the wardrobe in the movie. The wardrobe is the star of the film, followed by close ups from the four fab fems!

And the clothes didn’t disappoint. Whether you liked them, got them, wanted them, or not, you noticed them. Most of us don’t get to see clothing like this much. There are few cities, even fewer streets, where these clothes are for sale and  worn. But the impact of a big fashion film like Sex & The City on our personal style choices is huge. Why? It gives us freedom…freedom to push the envelope,  to break the rules and make new ones - white shoes after labor day, anyone?

Many of us  worry about how we look in our clothing, we struggle to find clothes that fit AND flatter. A movie like Sex & The City raises questions about how we really feel about following fashion:  Can we fall in love with a “fad,” make a style statement without wearing designer clothing or wearing a smaller size?

Yes to all of the above. Here are six suggestions to take the heat off Summer in The City.

Style Tips for Summer

> use self tanner on legs - tan legs camouflage veins and cellulite

> wear leggings under a baby doll top with ballet flats  - longer tunic length covers tummy, umpire waist is youthful, narrow legging suggests longer and leaner. leggings come in different lengths so you can find one that works for your leg shape, ballerina shoes elongate the foot, open up the ankle

> try some lip gloss - gloss is fun to wear and attracts attention to the face and sparkling smile

> get a french manicure for your toe nails - pretty, soft, sexy

> add color - try a gauzy, crinkled skirt or a v-neck t-shirt in a color that makes your eyes look bright - shades of blue, lavender and light green look good on everyone

> experiment with a hair product and wear your hair in a more natural, carefree way - add an accessory like a patterned scarf or head band.

My Summer In The City
Reading: Look Fit & Fabulous in 15 Minutes by Teresa Tapp www.t-tapp.com
Watching:  Sophia Loren in That Kind of Woman on TCM - Turner Classic Movies - ( you’ll love seeing how voluptuous she and Barbara Nichols are in this film! )
Drinking: Crystal Light Spritzers -  Half and Half Orange Grapefruit Flavor with Crystal Geyser Sparkling Lime Water
Activity: Swimming Every Day - wearing my sexy and sturdy Miraclesuit from www.Cyberswim.com
Listening: “I’ve Just Seen A Face,” by The Beatles, Soundtrack to Help!

Exercise is the key for the pre and post Bariatric patient to maintain a healthy range BMI and to become more independent, with increased base line functional movement. The question of exercise is something that is under increasing debate in the Bariatric community. Some surgeons recommend a structured and progressive exercise routine, such as stretching and a basic walking regimen, while other surgeons feel that it is less important. They may feel it is less important because the actual exercise routine may only burn 150-250 calories after 20-30 minutes of slow walking. This may seem overwhelming to the obese patient, especially if he/she has many health concerns such as high blood pressure or joint concerns. In order to lose one pound of fat through exercise one must burn 3500 calories or some combination of increased activity and decreased caloric consumption.

Many patients both pre and post Bariatric surgery feel frustrated when they only burn 100-200 calories after a power walk. Depending on the weight class range certain patients feel short of breath even taking 50 steps. The point is every person is an individual and every workout should be customized based on of course, your individual Bariatric surgeons recommendation, and your own check in assessment of how you are feeling. One day you may feel you have more energy than others and some days your joints may not fell up to excess movement. Therefore, it is essential to educate your self on ways to adjust your intensity on days your motivation and energy level is lower. I recommend purchasing a pedometer to check your step count and a diary to record the steps of how you’re feeling after each workout. As you progress you have a recording of your exercise progress chart, which is a solid indication of overall improvement. This information should be shared with your surgeon and or your support group leader so that they may advise you to increase or decrease your intensity and duration. This will also motivate you in the future when you refer back to a time when you were unable to move as freely or experienced a fatigue at a shorter interval of walking.

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For those who have struggled with weight from childhood into adulthood, we are forever hopeful that a certain diet regimen, over-thecounter diet product or pill or participation in a commercial weight loss program will be the “magic” answer to our seemingly endless weight gain frustrations. We often find ourselves in a disappointing situation: We begin with a high expectation of what any weight loss procedure can do without a realistic plan of how to get to our goal and maintain it. This often recalls the old dieting roller coaster mentality of temporary success with the frustration of regaining weight down the line. Bariatric surgery is not a temporary solution; the trick is to view bariatric surgery as a journey in the sense that it’s a life transition, a lifestyle change and a quality of life enhancer.

The existence of a permanent solution to struggle with weight through a surgical option presents both excitement and trepidation. When patients begin to investigate bariatric surgery, they are often flooded with seductive thoughts of incredible weight loss, increased confidence and attractiveness as well as the resolution of major medical co-morbidities. Surgery will certainly provide patients with the results they seek if patients are able to understand the importance of having manageable goals and realistic expectations during the post-operative healing and recovery period. It is essential that patients comprehend the difference between high expectations pre-operatively and realistic outcomes post-operatively in all areas of recovery: medical, nutritional and psychological. Every patient is an individual with their own set of needs and circumstances; a comprehensive bariatric program will recognize that fact and evaluate each patient and their particular needs.

Medical

Bariatric surgery will alter one’s bodily functioning through food restriction or food restriction with a bypass feature that encourages food malabsorption in the digestive tract.

One should recognize the lengths that a patient goes to in obtaining the placement of this “tool” to encourage weight loss and the resolution of chronic medical conditions and body pain.

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